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Fri, Aug 22, 2014

DR. KESTNER: Lower back pain may be caused by foot problems

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A woman in her mid-40s came to see me several years ago about ongoing lower back pain, which she had been having for about two years but could not recall any specific spinal injury.

She said that she had seen some other doctors about the pain and that it would get better for a while but always return. Medication helped temporarily. Low back exercises helped a little, but the pain never really went away. She always had tightness in her back and had trouble sleeping.

As I examined her, I found that she had some back problems related to muscle contracture and distorted posture. I also noticed one hip was slightly lower than the other, causing her pelvis to be tilted and twisted slightly. These postural distortions were likely causing much of the continuous back muscle tightness.

I continued to search for the cause of the pelvic misalignment. I found that her right knee was turned inward and bowed slightly compared to the left. I then found that the arch in her right foot was completely flat while the left one was normal.

“Oh yeah, I’ve had problems with that foot for years,” she said, after I asked about foot. “I hurt it about eight years ago when I jumped off the back of a pick-up truck. It hurt for weeks but eventually eased up.”

When I asked if she had ever seen a doctor about her foot, she said she had not since she began taking some pain medicine left over from a shoulder surgery several months previously.

She said the pain medicine helped her get through the few weeks that she had severe pain.

“So, you never had a foot doctor or your primary care doctor look at your feet?” I asked.

“No. I didn’t think I needed to (because) it started feeling better.”

One of my first recommendations was to place a temporary arch support in her shoe, which I wanted her to wear it all the time. I also provided some treatment for her spinal joints and muscles.

Within a couple of weeks she was doing much better. I then asked her to not wear the arch support. Within a few days, she was having back pain again.

I fitted her with custom made orthotics for her shoes to provide support for the chronic arch injury. I also provided foot and ankle manipulations to help restore improved function to those joints.

Not only did her foot pain go away, but so did her back pain.

When I saw her a year or so later in a store, she told me that she rarely had back discomfort and had learned to wear the orthotics all the time.

If this lady had seen her primary care doctor and referred to a podiatrist or other foot doctor after her injury, she may not have suffered with back pain for so long.

In her case, the fact that her arch was collapsed caused the leg on that side to be “shorter.” The leg bones were not actually shorter, but because the arch was flattened, it created the effect of a short leg. When she wore the proper orthotics, her leg was supported as well and her hips and pelvis became level again, reducing the chronic strain on her back.

Wearing proper footwear, maintaining good foot hygiene, and otherwise taking care of your feet is essential.

If a person experiences an injury, ongoing foot pain, or develops calluses or other foot deformities, it is important to see a foot specialist.
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Dr. Kestner
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